發(fā)布時間：2018-05-25 00:02

  本文選題：腸內(nèi)營養(yǎng) + 潰瘍性結(jié)腸炎�。� 參考：《吉林大學(xué)》2016年碩士論文

【摘要】：研究背景及目的:潰瘍性結(jié)腸炎(UC)是一種發(fā)生于粘膜層即腸壁表面的自身免疫性疾病,多位于乙狀結(jié)腸和直腸,也可延伸至降結(jié)腸,甚至整個結(jié)腸。其病因不明,可能與遺傳、免疫、感染及飲食等有關(guān)。臨床表現(xiàn)為腹瀉、血便、腹痛等。該病多見于西方國家,尤其是在歐美國家,在我國近年報道的病例明顯增多,可能與我國人民生活水平提高后,飲食特點越來越接近西方化(高脂肪和精制碳水化合物和低纖維)有關(guān)。UC是一種慢性病,常反復(fù)發(fā)作。其并發(fā)癥很多,體重減輕與營養(yǎng)不良也是UC患者的常見并發(fā)癥。營養(yǎng)不良可導(dǎo)致患者發(fā)育不良、腸道黏膜免疫紊亂、菌群失調(diào)、病情進(jìn)展或加重,有惡變的可能。再者藥物療效差或病情加重,使患者感到緊張、焦慮、失眠等嚴(yán)重影響患者的生活質(zhì)量。所以有必要進(jìn)行營養(yǎng)干預(yù)改善機體的營養(yǎng)狀況,誘導(dǎo)疾病進(jìn)入緩解期,改善患者的生活質(zhì)量。本研究通過對活動期UC患者進(jìn)行營養(yǎng)干預(yù),來探討腸內(nèi)營養(yǎng)對潰瘍性結(jié)腸炎患者的療效評價及生活質(zhì)量評估;進(jìn)一步對不同嚴(yán)重程度、病變范圍的UC患者的臨床療效進(jìn)行比較。方法:選取2014年4月~2016年3月就診于吉林大學(xué)白求恩第一醫(yī)院的52例確診為潰瘍性結(jié)腸炎患者作為研究對象,完成病例資料的收集,內(nèi)容包括姓名、性別、年齡。按照病變部位分為為直腸、乙狀結(jié)腸型,左半結(jié)腸型、全結(jié)腸型,根據(jù)改良Truelove和Witts分型標(biāo)準(zhǔn)將UC患者分為輕、中、重三型。將以上入選的52例UC患者隨機分為兩組,對照組(傳統(tǒng)抗炎治療+少渣飲食),實驗組(對照組+整蛋白型腸內(nèi)營養(yǎng)劑),統(tǒng)計治療前后的血紅蛋白(HB)、總蛋白(TP)、白蛋白(ALB)、體重、血沉(ESR)、C反應(yīng)蛋白(CRP)、內(nèi)鏡下表現(xiàn);隨訪患者治療前后臨床表現(xiàn)、不良反應(yīng)、日�；顒�、情緒變化;采用美國研究所研制的SF-36生活質(zhì)量表對患者治療前后現(xiàn)場填寫生活質(zhì)量表進(jìn)行生活質(zhì)量評估;統(tǒng)計學(xué)分析應(yīng)用SPSS 21.0統(tǒng)計軟件,計數(shù)資料用例數(shù)(n),兩組一般情況比較采用t檢驗和?2檢驗;兩組營養(yǎng)指標(biāo)、炎性指標(biāo)比較采用t檢驗;兩組臨床療效的有效率比較采用?2檢驗;兩組患者SF-36量表比較采用秩和檢驗。所有檢驗均以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1、一般情況一般情況包括年齡、性別、病變類型、病變范圍、嚴(yán)重程度,兩組對照差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。2、營養(yǎng)指標(biāo)本研究營養(yǎng)指標(biāo)包括:ALB、TP、HB、體重。實驗組和對照組ALB、TP、HB在治療前比較大致相同,不具有統(tǒng)計學(xué)意義(P0.05),實驗組治療后各營養(yǎng)指標(biāo)較治療前明顯升高,差異有統(tǒng)計學(xué)意義(P0.05)。而對照組治療前后比較變化不明顯,差異無統(tǒng)計學(xué)意義(P0.05)。兩組在治療后各營養(yǎng)指標(biāo)比較,實驗組明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。3、炎性指標(biāo)本研究炎性指標(biāo)包括:ESR、CRP。實驗組和對照組在治療前比較,ESR、CRP的差異均無統(tǒng)計學(xué)意義(P0.05);實驗組治療后各炎性指與治療前比較都有明顯降低,差異有統(tǒng)計學(xué)意義(P0.05);而對照組各炎性指標(biāo)治療前后比較變化不明顯,差異無統(tǒng)計學(xué)意義(P0.05)。實驗組和對照組治療后各炎性指標(biāo)ESR、CRP比較,差異有統(tǒng)計學(xué)意義(P0.05)。4、臨床療效治療后實驗組療效的總有效率為88.9%,對照組為48%,實驗組明顯優(yōu)于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。4.1根據(jù)嚴(yán)重程度進(jìn)行臨床療效比較輕度UC患者的臨床療效比較:實驗組和對照組差異無統(tǒng)計學(xué)意義(P0.05);中-重度UC患者的臨床療效比較:實驗組明顯優(yōu)于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。4.2根據(jù)病變部位進(jìn)行臨床療效比較直腸、乙狀結(jié)腸型的UC患者臨床療效,實驗組和對照組比較差異無統(tǒng)計學(xué)意義(P0.05);左半結(jié)腸型的UC患者的臨床療效比較,兩組差異無統(tǒng)計學(xué)意義(P0.05);全結(jié)腸型UC患者的臨床療效比較:實驗組明顯優(yōu)于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。5、生活質(zhì)量評估生活質(zhì)量量表的各個維度比較:治療前,實驗組和對照組比較差異無統(tǒng)計學(xué)意義(P0.05),治療后,實驗組和對照組9個維度評分都比治療前增高,差異有統(tǒng)計學(xué)意義(P0.05),治療后。2組生活質(zhì)量表的各個維度比較,差異均有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、多部位病變和中-重度的UC患者,應(yīng)給予充足的腸內(nèi)營養(yǎng)支持,療效較好2、腸內(nèi)營養(yǎng)支持可以作為活動期UC患者的臨床輔助治療3、藥物聯(lián)合腸內(nèi)營養(yǎng)支持更具臨床療效4、腸內(nèi)營養(yǎng)有利于營養(yǎng)不良癥的改善、有效地緩解臨床癥狀、改善腸道黏膜免疫功能還能更有效的提高生活質(zhì)量。
[Abstract]:Research background and purpose: ulcerative colitis (UC) is an autoimmune disease occurring on the surface of the mucosa of the mucosa, mostly in the sigmoid colon and rectum, and can also extend to the descending colon and even the whole colon. Its etiology is unknown, which may be related to heredity, immunity, infection and drinking. The clinical manifestations are diarrhea, bloody stool, abdominal pain, etc. In the western countries, especially in the European and American countries, the cases reported in recent years have increased significantly in our country. After the improvement of the living standards of our people, the dietary characteristics are becoming more and more close to Westernization (high fat and refined carbohydrates and low fiber)..UC is a chronic disease, often recurring. There are many complications, weight loss and nutrition. Malnutrition is also a common complication of UC patients. Malnutrition can lead to dysplasia of the patients, intestinal mucosal immune disorder, dysbacteria, progress or aggravation of the disease, the possibility of malignant change. Moreover, the drug effect is poor or the condition is aggravated, so that the patient feels nervous, anxiety, insomnia and so on seriously affect the quality of life of the patient. Therefore, it is necessary to do nutrition dry. To improve the nutritional status of the body, induce the disease to enter the remission period and improve the quality of life of the patients. This study explored the efficacy and quality of life of enteral nutrition in patients with ulcerative colitis by nutritional intervention in active UC patients, and further to the clinical efficacy of UC patients with different severity and range of severity. Methods: 52 cases of ulcerative colitis diagnosed in the first hospital of Bethune, Jilin University, April 2014, were selected as the subjects of ulcerative colitis. The case data were collected, including the name, sex and age. According to the lesion, the patients were divided into rectum, sigmoid, left semicolon, and all colonic type, according to the change. The Truelove and Witts classification standards were divided into light, medium, and heavy three patients. 52 cases of UC were randomly divided into two groups, the control group (traditional anti-inflammatory treatment + less slag diet), the experimental group (control group + Intacted Protein Enteral Nutrition Powder), the blood erythroprotein (HB), total protein (TP), albumin (ALB), weight, ESR), C counter before and after the treatment. CRP, endoscopy, follow-up of clinical manifestations, adverse reactions, daily activities, and emotional changes before and after treatment, and the quality of life assessment of the quality of life for patients before and after treatment by the SF-36 life quality table developed by the American Institute; statistical analysis and application of the SPSS 21 statistical software, and the number of use cases (n), Two groups of general conditions were compared with t test and 2 test; two groups of nutritional indicators, inflammatory indexes compared with t test; two groups of effective efficacy compared to 2 test; the two group SF-36 scale compared with the rank sum test. All the tests were statistically significant with the difference of P0.05. Results: 1, general general conditions include age, sex. There was no statistically significant difference between the two groups (P0.05) and comparable.2. The nutritional indexes included ALB, TP, HB, and weight. The experimental and control group ALB, TP, HB were roughly the same before treatment, and were not statistically significant (P0.05). The nutritional indexes of the experimental group were compared with the treatment. The difference was statistically significant (P0.05), but there was no significant difference in the control group before and after treatment (P0.05). In the two groups, the experimental group was significantly higher than the control group after the treatment. The difference was statistically significant (P0.05).3. The inflammatory indicators included the ESR, CRP. experimental group and the control group. There was no significant difference between ESR and CRP in the group before treatment (P0.05), and there was a significant reduction in each inflammatory finger after treatment in the experimental group (P0.05), but the difference was not significant before and after treatment in the control group (P0.05). The inflammatory properties of the experimental group and the control group after treatment were not statistically significant. Index ESR, CRP comparison, the difference was statistically significant (P0.05).4, the total effective efficiency of the experimental group after clinical curative effect was 88.9%, the control group was 48%, the experimental group was obviously superior to the control group. The two groups were statistically significant (P0.05).4.1 according to the severity of the clinical curative effect comparison of mild UC patients compared with the clinical effect: experimental group and the experimental group. There was no statistically significant difference in the control group (P0.05); the clinical efficacy of moderate to severe UC patients was compared: the experimental group was significantly better than the control group (P0.05), the difference was statistically significant (P0.05). The clinical efficacy of.4.2 was compared with the rectal and sigmoid colon type UC patients, and there was no significant difference between the experimental group and the control group (P0.05); The clinical efficacy of the semicolon type UC patients was compared, the difference between the two groups was not statistically significant (P0.05); the clinical efficacy of the total colon type UC patients was compared: the experimental group was significantly better than the control group, the difference was statistically significant (P0.05).5, the quality of life assessment of the quality of life of each dimension comparison: before the treatment, the experimental group and the control group were different. Study significance (P0.05), after treatment, the 9 dimensions of the experimental group and the control group were all higher than before the treatment, the difference was statistically significant (P0.05). The differences in each dimension of the quality of life of the.2 group after treatment were statistically significant (P0.05). Conclusion: 1, the patients with multi site disease and moderate to severe UC should be given adequate enteral nutrition support, the curative effect should be given. 2, enteral nutrition support can be used as a clinical adjuvant therapy of 3 in active UC patients. The combination of drug and enteral nutrition support is more effective than 4. Enteral nutrition is beneficial to the improvement of malnutrition. It can effectively alleviate the clinical symptoms and improve the intestinal mucosal immune function, which can improve the quality of life more effectively.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R574.62

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